Any input on this would be greatly appreciated:
Saturday morning, get up and drive 2 hours to take friend's boat for maiden voyage and do a fairly simple dive. All goes well, no excess exertion, no ascent violations on the computer, 81 foot dive, 57' average depth, 31 minutes, 54 deg F, 5mm wetsuit, hood, gloves. Surfaced at 1:30pm, and shrugged out of our gear, since the dive ladder was flimsy. I stayed in water and was the "booster", to help get the gear into the boat (he was diving double steels, I had AL 80, since he told me the boat was not yet set for diving). I climb into the boat and bark my shin on the ladder...no big deal. We stand around, leaning on sides of boat for ~10 minutes talking about how well the dive went. I noticed that my left arm was weak, and I was having trouble lifting it. Thought crossed my mind that I had worked out extra hard at gym yesterday, and it was coming back to bite me. Boat swayed a bit, and I fell down.....oops. Got up, boat swayed again...I fell again...absolutely no strength in my left leg. No pain, no discomfort, but I couldn't get up, and couldn't push up with my left arm. The weakness got worse until I couldn't move my entire left side....I mean AT ALL. I slipped off the motor cover, where I was laying, and my arm whipped across my face like a dead thing.
No blurred vision, no confusion, no trouble breathing, no pain, no tinnatus. Boat ride home took ~35 minutes. During that time, left side of my body was cold (like if you put a string around your finger for a couple minutes), my sense of touch was very much reduced, but also hypersensitive (when I bumped my L hand with my right, I wouldn't feel it, except as pressure in my wrist joint, but when buddy tried to help me up, could feel every hair on my arm pressed under his hand).
Had same sensation on L side of torso, and think muscle strength was also impaired, since I couldn't turn my body. Left side of face also felt numb, and felt "clumsy" when forming words, but stayed conscious and lucid the whole way. I did neuro exams on myself on the way in to assess deficits and hypersensitivities. The right side of my body did not seem affected at all (difficult to assess strength relative to normal, but was fairly strong)
Because this was the first dive outing on this boat, we had forgotten to pack an O2 kit, and we were both diving air, so I was not on O2 on the way in.
About 10 mins from the dock, I became able to move my foot a bit (~45 mins from onset), and gradually got a tiny bit of strength back. It took 2 people steadying me, and me hopping to get me from the boat to my vehicle ( since I knew the area well, I knew that I could drive myself to the hospital faster than I could summon an ambulance). My wife drove me to the hospital, 35 mins away. By the time we pulled up to the hospital, I was able to walk into emerg by myself....still a bit weak, but fairly steady. (Now about 1:30 after onset).
Suggested they phone DAN, which they did, got sent to nearest hyperbaric chamber and met with local hyperbaric doc. Got there about 5 hours after onset, symptom free. Examined by hyperbaric doc, who called DAN a couple times with updates on my condition, and his opinions. Through consultations, was decided that there was no reason to "dive" me in the chamber, since I was symptom free, and they just observed me overnight. Am home now.
Pertenant background on me is that I am a fairly active diver, having done about 60 dives this year, >15 below 150' with planned decompression. I am relatively fit (could still lose a few pounds), 36 years old. My blood pressure is OK (132/84 in the hospital), and a Heartrate of 55.
I am currently awaiting a call from the neurologist, who is going to work me up to see if he can find the source of the problem. An echocardiogram, and carotid artery doppler exams are in the works to see if there is a source of clots hanging out in either of these areas. Hyperbaric doc says that if neuro cant find anything, we will have to revisit a bubble as the cause of the problems, and try to figure things out re: my diving future.
For the medical types, I have an interventricular septal defect, with a shunt fraction of about 10%, and R and L ventricular pressures within normal limits (last echocardiogram was 2 yrs ago)
QUESTIONS:
** did I have DCS? other rule outs are TIA (transient ischemic accident), which is basically a mini-stroke that resolved itself before any brain tissue died.
** has anyone seen a case like this before....I have a strong background in physiology,and functional anatomy, (I'm a veterinarian), and know of only a couple ways you could get hemi-paresis/paralysis on one side of the body while the other side is basically unaffected. Most times, an injury that would affect the left arm AND leg would have to be diffuse and injure a large section of brain, or possibly spinal cord.
** since the symptoms resolved without O2 treatment, is it correct to assume that the damage was not caused by DCS, OR is it possible that many DCS hits that resolve on O2 therapy would have resolved without it, and I could still have had a bubble?
**does anyone know if the timeline seems reasonable for onset and resolution of symptoms assuming that TIA was the reason for the problems
If you have any input, or any more questions, I would be interested in hearing from you....If I cant find the root cause of this, I am going to have to seriously consider giving up diving, because if the symptoms had been permenant, my future was going to be massively altered, and not for the better.
Thanks
Wetvet
